In the face of unmanageable pain, fear, grief, or illness, our psychological survival depends not only on a person’s strength, but also on the availability of others to help deal with distress. In his lonely deprivation, Hicks may have been helped by the respect of his lawyers and his parents’ love, but his isolation – political and personal – over five years means that his capacity to deal with adversity will have been exceeded.

I have not been to Guantanamo Bay, but as a consultant psychiatrist, I have assessed many men who have spent years in Immigration Detention in Australia. There are certain parallels with Hicks’s detention.

The detainees’ path is predictable. As their frustration increases, protests became more prominent, often in the form of self-violence. This protests gradually gave way to withdrawal. In an act of both physical and mental withdrawal, they would stop eating and take to their rooms where they would fixate on the unfairness of the system and about their own shortcomings. By this stage, the men stopped causing trouble for the guards. Although their capacity to make any real human contact is impaired, many could still socialise for a few minutes at a time. Most detainees were reported to be sleeping excessively, but in fact told me they did not sleep. I suspect that their horrid, half-waking ruminations looked to their guards to be ordinary sleep. Perhaps misperceptions like this generated the reports that have reassured the Attorney-General:

People respond to detention in different ways … I don’t hear most people who are detained in Australia are found to be unfit to plead simply because they’ve been detained. Some people don’t handle it well.

And the Prime Minister:

The Consul-General went to see him, and he refused to talk with him. Now, that is his right, but it does create a situation where in a sense the Australian Government is damned if it does, and it’s damned if it doesn’t.

The fact is, with prolonged incarceration my patients lost all hope, and their thinking became confused. Several immigration detainees rejected offers of “help”, just as Hicks rejected approaches from the Australian Embassy. Many of them heard voices and came to irrational convictions. All were eventually diagnosed with more than one severe psychiatric condition: major depression, a panic disorder or psychosis. Meaningful psychiatric care was impossible while they remained in the environment that had driven them mad.

I have doubted that such detainees have the capacity to represent their own needs, just as Hicks’s lawyers doubted “that he was in a position to understand what we were imparting to him”.

Everything we know is consistent with David Hicks being seriously psychologically impaired in the same way as the immigration detainees, which makes independent psychiatric evaluation a matter of urgency. Sadly, after such prolonged despair, repatriation or a more humane incarceration carries no guarantee of recovery.

Peter Fray

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